Does non-implanted electrical stimulation reduce post-stroke urinary or fecal incontinence? A systematic review with meta-analysis

Abstract

Background: Urinary and fecal incontinence are disabling impairments after stroke that can be clinically managed with electrical stimulation. Aim: The purpose of this systematic review was to determine the effectiveness of non-implanted electrical stimulation to reduce the severity of post-stroke incontinence. Summary of Review: Clinical trials of non-implanted electrical stimulation applied for the purposes of treating post-stroke incontinence were searched in MEDLINE, EMBASE, CINAHL, PEDro, and CENTRAL. From a total of 5043 manuscripts, 10 trials met the eligibility criteria (n = 894 subjects). Nine trials reported urinary incontinence severity outcomes enabling meta-analysis of transcutaneous electrical nerve stimulation (TENS; 5 trials) and electroacupuncture (4 trials). Studies provide good-to-fair quality evidence that TENS commenced <3 months post-stroke has a large effect on urinary continence (SMD = -3.40, 95% CI -4.46 to -2.34) and a medium effect when commenced >3 months after stroke (SMD = -0.67, 95% CI -1.09 to -0.26). Electroacupuncture has a large effect when administered >5 times a week (SMD = -2.32, 95% CI -2.96 to -1.68) and a small effect when administered 5 times a week (SMD = -0.44, 95% CI -0.69 to -0.18). Only one trial reported the effect of non-implanted electrical stimulation on post-stroke fecal incontinence. Conclusions: Published trials evaluating the effect of non-implanted electrical stimulation on post-stroke incontinence are few and heterogenous. Synthesized trials suggest that early and frequent treatment using electrical stimulation is probably more effective than sham or no treatment. Further trials measuring incontinence in an objective manner are required.

Global trends and development of acupuncture for stroke: A review and bibliometric analysis

“…The analysis of countries shows that the country with the greatest numbers of papers and citations is China, which may be due to the Chinese origins of acupuncture. However, the United States has the highest number of citations per paper (40), indicating that the quality of these research papers is widely recognized to be high. As shown in the figure, in terms of national cooperation, China and the United States have the closest connection, while there are fewer links between other countries; a stronger network of collaboration should be established among more countries.…”

“…Clinical studies have demonstrated that EA can effectively treat various sequelae of stroke, including dysphagia, [37] pain, [38] aphasia, [39] and urinary incontinence. [40] A review of animal experiments suggested that EA could alleviate ischemic brain injury by engaging in various signaling pathways and regulating multiple molecular processes such as cell apoptosis, inflammation, and autophagy. [41] Another study found that EA after ischemic brain injury might achieve neuroregeneration or neuroprotection by inhibiting apoptosis, reducing glutamate excitotoxicity, enhancing cerebral blood flow and growth factor production, modulating oxidative damage, maintaining blood-brain barrier integrity, and increasing cerebral ischemic tolerance.…”

Urinary dysfunction in patients with vascular cognitive impairment

“…A meta-analysis revealed that daily transcutaneous electrical nerve stimulation (TENS) and electroacupuncture at least 5 days per week starting less than 3 months post-stroke may be effective for treating urinary incontinence ( Cruz et al, 2021 ). Another meta-analysis found that TENS may reduce the severity of urinary incontinence ( Thomas et al, 2019 ) and that both TENS and neuromuscular electrical stimulation can reduce symptoms of post-stroke urge incontinence ( Ali et al, 2022 ).…”

Visual bibliometric analysis of electroacupuncture research in stroke treatment: a 20-year overview

“…In animal experiments, EA alleviates ischemic brain damage by regulating apoptosis, inflammation, autophagocytosis, glutamate, mRNA, and other factors ( Xing et al, 2018 ). In clinical applications, EA is an effective treatment for stroke symptoms such as dysphagia ( Huang et al, 2020 ), pain ( Xu et al, 2020 ), aphasia ( Shi et al, 2022 ), and urinary incontinence ( Cruz et al, 2022 ).…”